Lab K Neb CPT

Lab NO 9 Aerosol, Chest physiotherapy and Suctioning
MEDICATION NEBULIZER
OBJECTIVE
The student will be able to correctly assemble the necessary equipment and administer
a medication nebulizer in a laboratory setting. This will be done following aseptic
guidelines and in a competent manner as determined by lab and clinical instructors.
TASK A: Review the Chart.

Before proceeding with this procedure, the patient chart should be reviewed. The
student should first check the order to assure that the prescribed medication and
dosage are being followed. Evaluate the presence of any contraindications to the
therapy and the patient's current condition as noted in the progress and nursing notes.
This will help the student prepare for interaction with the patient and any potential
changes that may be warranted in the therapy.
The patient's past response to previous therapy should be reviewed for possible
adverse side effects or other problems encountered. These notes should serve as a
follow-up and reminder of the report received on the patient. During the chart review,
the student will note any orders or indications for patient isolation techniques.
TASK B: Obtain Equipment.

The student will first obtain the medication nebulizer. A mouthpiece, tee piece,
reservoir tube, and connecting tube, should be included or acquired.
Next, obtain a flowmeter or compressor to power the nebulizer. Under normal circum-
stances, the nebulizer will be powered by a flowmeter.
Now get the prescribed medication. Make sure that the concentration is correct and
that the expiration date has not been passed. You will also need to obtain sterile saline
or other diluent for the medication at this time.
Some patients require nose clips to properly inhale during the treatment. It is best to
have some nearby before beginning the treatment rather than stop the treatment to
seek a pair.
A stethoscope is necessary to evaluate the breath sounds both before and after the
treatment. The bell should be appropriately sized for the patient.
The measurement of peak expiratory flow rates and vital capacity are done before and
after the administration of the therapy to evaluate the effectiveness of bronchodilation.
You will therefore require both a peak flowmeter and a device to measure vital
capacity at this point.
On unstable patients, it may be desirous to monitor the blood pressure throughout the
treatment. If indicated, obtain the sphygmomanometer at this time.
Finally, because of the probability of contact with secretions, the student should
obtain a pair of exam gloves before continuing with this procedure.
TASK C: Wash Hands.

Upon completion of gathering the desired equipment, the student should perform a
thorough hand washing followed by placement of the gloves.
TASK D: Confirm Patient.

Before administering any drug to a patient, confirm that you have the correct patient
by looking at the name bracelet attached to a patient limb.
TASK E: Obtain Baseline Vital Signs.
1
Before administering the therapy, the student should auscultate the patient's lungs and
determine breath sounds. Careful auscultation is invaluable at this point in
determining a baseline for comparison following the therapy.
The student should also obtain the pulse rate, respiratory rate and effort, vital capacity,
and peak flow. Obtain the blood pressure as required.
TASK F: Position Patient.

To achieve the best expansion of the lung bases, the patient should be elevated to an
upright position for taking the treatment. On patients who are unable to be elevated,
the therapy must be modified as needed to be delivered in the necessary position.
TASK G: Administer the Therapy.

First, assemble the nebulizer by placing the tee piece on the nebulizer, inserting the
mouthpiece into the tee piece, and placing the reservoir tubing opposite the
mouthpiece on the tee piece. Now add the prescribed medication and diluent to the
nebulizer. Depending on the type of nebulizer, this is done by either unscrewing the
nebulizer or adding the liquids to the lower reservoir or by removing the tee piece and
adding the liquids through the nebulizer outlet.
Now connect the nebulizer to the flowmeter or compressor with the connecting tube.
Turn on the flow to assure proper function of the nebulizer. Most nebulizers require
flows of 5 to 6 L/min to achieve the desired particle size, but in all cases, follow the
manufacturer's recommended flow rate for the nebulizer being used.
The nebulizer is now ready for the patient. Place the mouthpiece between the teeth
and the lips and have the patient close the teeth to provide a seal around the
mouthpiece. The patient is then coached in the proper breathing technique of slow
deep inhalations through the mouth followed by a slight breath hold before
exhalation. Patients who have trouble breathing through the mouth may require the
use of nose clips.
TASK H: Monitor the Patient.

During the treatment, the patient is monitored for pulse rate, respiratory rate and
pattern, and any adverse side effects. Blood pressure is monitored on unstable
patients. The treatment is terminated if any of the following occur:
1. Increase of 20 beats per minute of the heart rate.
2. Sudden chest pain.
3. A decrease in the blood pressure.
TASK I: Conclude the Procedure.

The treatment is terminated normally when the medication in the nebulizer has run
out. Remove the nebulizer from the patient's mouth and clean it by opening the
nebulizer and shaking any remaining medication from the nebulizer vial. The
nebulizer, tee piece, mouthpiece, and reservoir tubing should then be placed in a clean
location and allowed to air dry.
Now ask the patient to cough. Any secretions coughed up should be placed in a tissue
or other appropriate receptacle.
The student should now repeat the evaluation of breath sounds, pulse rate, respiratory
rate and effort, vital capacity, and peak expiratory flow rate. Blood pressure is
measured if necessary.
Return the patient to the previous or other desired position.
2
TASK J: Record in Patient Chart.

The final task in this proficiency is to chart the appropriate information in the patient
record. These data should include before and after parameters, vital signs, breath
sounds, description of patient toleration, sputum production, and any adverse effects.
TASK K: Hand Washing.

Wash hands again as appropriate.
3
PERFORMANCE EVALUATION
MEDICATION NEBULIZER
Student Name __________________ Date: Lab ___________________
Instructors Name _______________
PASSING CRITERIA:
Obtain 90 percent or better on the procedure. Tasks indicated by a dot (●)
must receive at least 1 point or the evaluation is terminated. The procedure must be
performed within the designated time or the performance receives a failing grade.
SCORING:
2 Points – Task performed satisfactorily without prompting.
1 Point – Task performed satisfactorily with self- initiated correction.
0 Point – Task performed incorrectly or with prompting re1quired.
NA – Task not applicable to the patient care situation.
TASKS:
A . Review chart
• check order
• contraindications
patient condition
• past response to therapy
• orders or indication for isolation
B. Obtain equipment
• medication nebulizer (to include tee piece, mouthpiece, reservoir tubing,
and connecting tubing)
• flowmeter or compressor
• prescribed medication
• a. correct concentration
b. check expiration date
• sterile normal saline
nose clips
• stethoscope
• peak flowmeter
• device to measure vital capacity
sphygmomanometer ( as applicable )
• exam gloves
4
• C. Wash hands; put on gloves

• D. Confirm and identify patient
E. Obtain baseline vital signs and parameters
• breath sounds
• pulse rate
• respiratory rate and effort
• vital capacity
• peak flow
blood pressure (as applicable)
• F. Place patient in upright position (as possible)
G. Administer therapy
assemble nebulizer
• tee piece on nebulizer
• mouhpiece inserted into tee
• reservoir tubing into tee
• place medication or saline and diluent into nebulizer ]
• connect nebulizer to flowmeter or compressor
• turn on flow to assure proper function (usually 5 to 6 L/min)
• place mouthpiece in patient’s mouth
place nose clips (as necessary)
coach patient in proper breathing technique
• a. slow deep inhalation through mouth
• b. small breath hold before exhalation
H. Monitor patient during therapy
• pulse rate
• respiratory rate and pattern
blood pressure as applicable
• adverse side effects
I. Conclude procedure
remove nebulizer and clean
• a. open nebulizer vial and sanitarily dispose of remaining medication
• b. place nebulizer in appropriate location to air dry
• have patient cough
5
reevaluate patient’s vital signs parameters

• a. breath sounds
• b. pulse rate
• c. respiratory rate and effort
• d. vital capacity
• e. peak flow
f. blood pressure (as applicable)
g.
• return patient to desired position
• J. Record results and observations
• K. Monitor appropriately
SCORE:
Lab: ________ points out of _________ (104) _________%
Time: _______ out of possible 15 minutes.
STUDENT SIGNATURES INSTRUCTOR SIGNATURE

_______________________ ________________________
6
CHEST PHYSIOTHERAPY
OBJECTIVE
The student will be able to properly position a patient and perform chest physio-
therapy (CPT) in a laboratory and clinical setting. This will be done following aseptic
guidelines and in a competent manner as determined by lab and clinical instructors.
TASK A: Review the Chart.

When initiating chest physiotherapy, it is important to verify that the order has been
written, along with the frequency and goals of the therapy. If this is the first time that
CPT will be performed, any contraindications or hazards should be determined, in
addition to the following: The volume and nature of the lung secretions, patho-
physiology of the lung disease, and current clinical condition.
If the patient has been receiving CPT, the response to past CPT treatments and
indications to modify the positions used to drain the affected lung regions should be
evaluated. A review of the latest chest x-ray will help evaluate any lung areas that
need special attention. During the chart review, the student will note any orders or
indications for patient isolation techniques.
TASK B: Obtain Equipment.

Now obtain any necessary equipment that will be used during the CPT treatment. This
will include a stethoscope, the equipment or device to be used to perform the
percussion and vibration, a resuscitation bag and mask, and suction equipment.
TASK C: Hand Washing.

A thorough hand washing should now be done. Asepsis must be maintained
throughout the treatment.
TASK D: Confirm Patient.

Proceed to patient room or bed and confirm that it is the correct patient by looking at
the patient's identification.
TASK E: Obtain Baseline Data.

Before starting the treatment, assess the patient's breath sounds, pulse rate, respiratory
rate, and color. A transcutaneous monitor or pulse oximeter should be used to monitor
the oxygenation status during the treatment.
TASK F: Position Patient.

The patient should now be positioned according to the lung area that is to be drained.
Determining the correct position is done by an understanding of the disease and the
goal of the CPT. If there is a specific lung segment involved, the position used would
drain that segment. CPT done for prophylaxis, or to help remove thick secretions, may
best be done by percussing over all lung fields. Correct positioning of the patient will
facilitate drainage and enhance the vibration or percussion of the desired area. After
determining the appropriate position, place the patient accordingly.
These positions may need to be modified in certain instances. For example, the
critically ill neonate may require too great an increase in FIO2 when positioned.
Neonates with chest tubes, endotracheal tubes, and I.V. lines require cautious handling
and may not tolerate changes in position. Care must also be taken with patients who
have a history of recent surgery.
7
Positions for Postural Drainage

Positions used to drain specific lung segments are primarily used on the older patient
and limited to those with involvement of a specific lung segment. Because CPT on the
neonate is often done prophylactically, with no specific process involved, positioning
is mainly done by placing the patient on one side. The side that is elevated is then
percussed, or vibrated. The patient is then turned on the opposite side, and the
procedure is repeated.
For patients in whom a specific lung segment is to be percussed and drained, a
description of the proper positions follows. Each position is shown accompanying the
descriptive text.
Upper Lobes, Posterior Segments
(Figure 9-1). Lean the patient over at a 30

degree angle from a sitting position and
percuss or vibrate over upper back on both
sides. The patient may also be placed on the
side opposite the affected side and rotated
slightly forward. Percussion and vibration
are then done on the upper back of the
affected side.
Figure 9-1
Upper Lobes, Anterior Segments
(Figure 9-2). This positioning is

accomplished by placing the patient on the
back, with the head of the bed elevated.
Percussion is then done between the nipples
and clavicles over the affected side.
Figure 9-2
Upper Lobe, Apical Segment
(Figure9-2). Lean the patient backwards about 30 degrees from a sitting position.
Percuss or vibrate above the clavicle over the involved area. The patient may also be
positioned on his or her back, with the head of the bed elevated. Percussion or
vibration is then done above the clavicles.
Right Middle Lobe
(Figure 9-3). The patient is positioned

on the left side, elevating the hips about
5 inches higher than the head. The
patient is then rolled backwards a quarter
turn. The patient is percussed over the
area of the right nipple.
Figure 9-3
8
Lingular Segments of the Left Upper Lobe
(Figure 9-4). Place the patient in the same position, only with the left side up.
Percussion is then done over the area of the left nipple.
Figure 9-4
Right Lower Lobe, Lateral Basal Segment
(Figure 9-5). Position the patient on his or her left side with the hips about 8 inches
higher than the head. The shoulders are then rolled forward one quarter turn.
Percussion is done over the lower ribs.
Left Lower Lobe, Lateral Basal Segment
Drainage of this segment is identical to that described for the right lower lobe, except
that the patient is placed on the right side.
Figure 9-5
Lower Lobes, Superior Segments
(Figure 9-6). The patient is positioned face down, with the bed flat. Percussion is then
done at the top of the scapula over the involved area.
Figure 9-6
Lower Lobes, Posterior Basal Segments
(Figure 9-7). The patient is placed face down, with the hips 8 inches higher than the
head. Percuss or vibrate on the involved side, over the lower ribs close to the spine.
9
Figure 9-7
Lower Lobes, Anterior Basal Segment
(Figure 9-8). Place the patient on the side opposite the involved area, with the hips
about 8 inches higher than the head. Percuss or vibrate just beneath axilla.
Figure 9-8
10
11
TASK G: Percuss Patient.

After the patient has been positioned, percussion is then started. Correct percussion
requires the use of appropriate equipment. Whichever type of percussor is used, it
should be small enough to cover the area involved and not extend beyond the ribs
onto the abdomen. It should be done at a relaxed but vigorous rhythmic rate and
should never be painful or stressful to the patient.
Excessive force when percussing does not increase the mobilization of secretions and
is never indicated. Percussion may produce skin erythema, a reddening of the skin, or
bruising. Avoidance of percussing over bony areas, such as the clavicles, sternum, and
vertebrae, will prevent bruising and potential fractures.
Extreme care must be taken not to percuss over the abdomen or outside the
boundaries of the thorax. Failure to do this may cause damage to internal organs and
tissues.
The duration of the CPT depends on how well the patient tolerates the treatment and
on the patient's condition. CPT done to the small neonate should be limited to 5
minutes per side. This reduces the stress on the neonate and the accompanying
changes in oxygenation and vital signs. If CPT must be done on the critically ill or
unstable patient, 2 or 3 minutes per side may be all that is tolerated.
When doing CPT on the pediatric patient, perform CPT first to the lobes most
affected, allowing 3 to 5 minutes per area. CPT is then done to other involved
segments as needed. The total treatment should not last longer than 10 to 20 minutes.
12
Longer treatments may tire the patient excessively and usually do not increase mucus
removal.
TASK H: Vibration.
Vibration can be done via mechanical vibrator or by hand. It is done following
percussion or in place of it, when indicated. Vibration is indicated over percussion on
neonates weighing less than 900 grams, those with chest tubes, and patients who are
postoperative.
Vibration is applied to the chest wall, above the desired area. This facilitates the
movement of the secretions from that lung area. Hand vibration is done by producing
a quivering motion similar to that during isometric exercises. Battery-operated
vibrators offer an easier and superior method of vibration. Many newly developed
vibrators are designed specifically for the neonate and concentrate the vibration to
small areas.
In substitution for CPT, vibration is done for approximately 5 minutes per area, for a
total of 10 to 15 minutes' duration. When done following percussion, vibration should
be limited to 2 to 3 minutes on each area.
TASK I: Monitor Patient.

Throughout the treatment the patient must be monitored for signs of distress. The
heart rate is most easily monitored by the ECG. Respiratory rate and pattern should be
assessed every 3 to 5 minutes. The treatment should be stopped if the patient becomes
tachycardia or bradycardic.
Signs of respiratory distress that were notp resent when the treatment was started are
indications for stopping the treatment and further evaluating the patient. The patient's
oxygenation status should be monitored as well. Small decreases in PaO2 or
saturation can be treated by increasing the FIO2, to achieve the desired level.
Prolonged or profound drops in Pa0„ however, requires that the treatment be stopped
and the patient further evaluated and treated.
TASK J: Conclude Procedure.

Following completion of the procedure, the patient is returned to the desired position.
The vital signs are reevaluated and compared to beginning vital signs.
The patient is now- prepared for suctioning. The patient may need to be suctioned at
any time during the treatment, but it is usually done following the CPT. The need for
suctioning is determined by observing the patient's response during the treatment.
Assessing breath sounds and close observation of the transcutaneous monitor and
pulse oximeter will also help in determining the need to suction.
TASK K: Documenting Procedure.

The procedure is completed by documenting all pertinent information in the patient
chart. This should include the positions used, duration of therapy, how the patient
tolerated the procedure, vital signs, breath sounds, and sputum production.
TASK L: Monitoring.
The appropriate timing and method of monitoring the equipment and the patient
should be determined. This is based on any orders, written department standards, and
patient condition.
13
14
CHEST PHYSIOTHERAPY
PASSING CRITERIA:
SCORING:
TASKS:
A . Review chart
• check order
• contraindications
secretions
pathophysiology of lung disease
patient condition
past response to therapy
• current chest x-ray
• orders or indications for isolation
• B. Obtain equipment
• stethoscope
• percussor
• resuscitation bag and mask
• suction equipment
• D. Confirm and identify patient
E. Obtain baseline vital signs
• breath sounds
• heart rate
• respiratory rate and effort
• color
15
• oxygenation status
• F. Place patient in appropriate position
G. Appropriate percuss patient
• correct equipment
• acceptable rate and rhythm
• appropriate striking force
• performed within boundaries
• appropriate duration
H.Vibration
• indications
proper equipment
appropriate duration
I. Monitor patient
• heart and respiratory rate
observe
• a. respiratory pattern
• b. patient appearance
J. Conclude procedure
return patient to desired position
• reassess vital signs
• appropriate suction patient
• K. Record results and observation
• L. Monitor appropriately
SCORE:
Lab: ________ points out of _________ (72) _________%

_______________________ ________________________
16
SUCTIONING:
ENDOTRACHEAL, OROPHARYNGEAL, AND NASOPHARYNGEAL
OBJECTIVE
The student will be able to properly suction a patient through the endotracheal tube,
orally and nasally, in a laboratory and clinical setting. This will be done following
aseptic guidelines under universal precaution procedures and in a competent manner
as determined by lab and clinical instructors.
Suctioning is the technique of inserting a catheter into the airway, applying a negative
pressure, and removing secretions through the catheter. It is recommended that it
always be done with two people, one to perform the suctioning procedure and the
other to monitor the patient and provide support as needed.
TASK A: Prepare Equipment.

The first task in preparing for suctioning the airway is the preparation of the
equipment. The appropriately sized suction catheter should be selected for the patient.
This selection of the appropriate suction catheter follows:
Suction Catheter Sizes (intubated patient)

Endotracheal Tube (mm I.D.) Suction Catheter (French)
2.5 5,6
3.0 5,6 to 8
3.5 8 to 10
4.0 8 to 10
Suction Catheter Sizes (non-intubated patient)

Age Suction Catheter (French)
Preemie 5,6
Term Newborn 5, 6 to 8
Newborn to 6 months 8 to 10
The next step, determining catheter insertion distance, applies only to endotracheal
suctioning. The proper catheter insertion distance is determined by noting the
centimeter mark on the exterior ETT that corresponds to the level of the adapter, as
illustrated in Figure 9-9.
The adapter length, which is approximately 4 cm, is added to the centimeter mark on
the ETT. This represents the distance from the tip of the ETT to the opening of the
adapter and can then be used to determine the appropriate depth of catheter insertion.
Once the insertion distance is determined it should be noted and placed on a card near
the patient's bedside. The vacuum pressure should be adjusted next. Occlude the
opening of the suction line and adjust the vacuum to -50 to -80 mmHg.
17
Figure 9-9
TASK B: Prepare Patient.

The patient should now be prepared for the procedure. As always, before touching the
patient, you must perform an adequate hand washing. The chest should now be
auscultated for the presence of mucus in the airways. The patient is then
hyperoxygenated by the assistant. This should be done 30 seconds to a minute before
the procedure. Observe and note the vital signs at this point, to include pulse rate,
respiratory rate, blood pressure (on unstable patients), and oxygenation status.
TASK C: Perform Procedure; Endotracheal Tube.

First, place eye protection. Aseptically open the suction kit, making certain not to
contaminate the catheter or gloves. Put the sterile gloves on, using sterile technique.
Using the dominant hand, carefully remove the catheter from the protective package.
If the patient is inside an incubator, the catheter should be wrapped around the hand or
inside the clenched hand to protect it from being contaminated as the hand is inserted
into the porthole.
The next step is to attach the suction catheter to the suction tubing, carefully
maintaining sterility. By holding the thumb port between the thumb and index finger
of the gloved hand, the catheter tubing connection can be pushed into the suction
tubing without contamination resulting. The assistant may now remove the ventilator
connection from the endotracheal tube and instill a sterile saline lavage into the
endotracheal tube. Preemies will require only a few drops to 0.5 ml saline lavage.
Older pediatric patients may require several milliliters of lavage to sufficiently loosen
secretions.
The patient is reattached to the ventilator for four or five breaths. The ventilator
connector is once again removed and the suction catheter is inserted into the
endotracheal tube, without applied suction, to the previously determined depth. The
thumb port is then occluded and the catheter is withdrawn. Some recommend the
intermittent application of suction.
The patient is immediately reattached to the ventilator, monitored, and treated for
bradycardia and hypoxemia. The suctioning is repeated as necessary until all
secretions are removed. The patient must be monitored for bradycardia and
hypoxemia throughout the procedure. Severe bradycardia (<100 beats per minute in
18
neonates) requires immediate cessation of the procedure. When the patient is stable,
the FiO2 must be returned to its pre-suction level.
TASK E: Perform Procedure; Oropharyngeal.

Although not a sterile procedure, it is recommended that the person performing the
oral suctioning wear exam gloves and eye protection during the procedure. If using a
catheter that does not contain gloves, the student should obtain them and put them on
at this point.
The catheter is next removed from the package and connected to the suction tubing.
Insert the catheter tip into the patient's mouth and carefully follow the surface of the
tongue to the oropharynx. Suction is now applied, and the catheter withdrawn. As
with endotracheal suctioning, some advise the use of intermittent suction.
Bradycardia and hypoxia are treated by the administration of oxygen. The technique
is repeated as necessary to remove all secretions.
TASK F: Perform Procedure; Nasopharyngeal.

Nasopharyngeal suctioning is accomplished in a manner similar to oropharyngeal
suctioning. Gloves and eye protection should be worn. You may either use a new
catheter or clean the catheter used to suction the oropharynx in sterile water before
use. It may be helpful to add a water-soluble jelly to the catheter to ease insertion into
the nose and reduce injury.
The catheter is inserted in a slightly upward direction and towards the back of the
head until it enters the nasopharynx. Suction is applied and the catheter is withdrawn.
As with the other suction procedures, some advocate the use of intermittent suction.
The patient is monitored and treated for any hypoxia and bradycardia. The procedure
is repeated as needed.
NOTE: The duration of the actual suction procedure should not be more than 10
seconds for any of the techniques.
TASK G: Document Procedure.

The final step in suctioning the patient is documentation in the patient chart. This
should include how well the patient tolerated the procedure, amount and color of
sputum, vital signs, and breathe sounds.
TASK H: Monitoring.
The appropriate timing and method of monitoring the equipment and the patient
should be determined. This is based on any orders, written department standards, and
patient condition.
19
ENDOTRACHEAL SUCTIONING
PASSING CRITERIA:
SCORING:
TASKS:
A. Prepare equipment
• select appropriate size catheter
•
• determine catheter insertion distance (when suctioning the et tube)

• adjust vacuum pressure(-50 to –80 mmHg)
• prepare ventilator manual
B. Prepare patient
• wash hands
•
auscultate chest and determine breath sounds

• hyperoxygenate as needed
•
• observe baseline vital signs

C. Perform procedure : Endotracheal tube
• place eye protection
•
• aseptically open suction kit

•
• aseptically place gloves

•
• remove catheter from package attach catheter to suction tubing

(do not contaminate sterile hand)
• disconnect patient form ventilator
•
• instill appropriate amount of sterile saline

•
• reconnect to ventilator (or manually ventilate) for 4 to 5 breaths

•
• insert catheter into Et tube without suction and advance

•
20
to predetermined depth
• applyintermittent suction and withdraw catheter
(total time should not exceed 10 sec)
• resume ventilation of patient
•
• observe vital signs and treat patient for bradycardia and/ or hypoxemia
•
resuction as needed following the given criteria

• return FiO2 to presuction level when clinically indicated
•
• D. Document the procedure and pertinent information in the patient

chart
• E. Monitor appropriately
SCORE:
Lab: ________ points out of _________ (48) _________%

_______________________ ________________________
21

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Lab NO 9 Aerosol, Chest physiotherapy and Suctioning

TASK A: Review the Chart.

TASK B: Obtain Equipment.

TASK C: Wash Hands.

TASK D: Confirm Patient.

TASK E: Obtain Baseline Vital Signs.

TASK F: Position Patient.

TASK G: Administer the Therapy.

TASK H: Monitor the Patient.

TASK I: Conclude the Procedure.

TASK J: Record in Patient Chart.

TASK K: Hand Washing.

Student Name __________________ Date: Lab ___________________

Instructors Name _______________

• C. Wash hands; put on gloves

reevaluate patient’s vital signs parameters

Time: _______ out of possible 15 minutes.

STUDENT SIGNATURES INSTRUCTOR SIGNATURE

TASK A: Review the Chart.

TASK B: Obtain Equipment.

TASK C: Hand Washing.

TASK D: Confirm Patient.

TASK E: Obtain Baseline Data.

TASK F: Position Patient.

Positions for Postural Drainage

Upper Lobes, Posterior Segments

(Figure 9-1). Lean the patient over at a 30

(Figure 9-2). This positioning is

Right Middle Lobe

(Figure 9-3). The patient is positioned

Lingular Segments of the Left Upper Lobe

TASK G: Percuss Patient.

TASK I: Monitor Patient.

TASK J: Conclude Procedure.

TASK K: Documenting Procedure.

Student Name __________________ Date: Lab ___________________

Instructors Name _______________

Time: _______ out of possible 15 minutes.

STUDENT SIGNATURES INSTRUCTOR SIGNATURE

TASK A: Prepare Equipment.

Suction Catheter Sizes (intubated patient)

Suction Catheter Sizes (non-intubated patient)

TASK B: Prepare Patient.

TASK C: Perform Procedure; Endotracheal Tube.

TASK E: Perform Procedure; Oropharyngeal.

TASK F: Perform Procedure; Nasopharyngeal.

TASK G: Document Procedure.

Student Name __________________ Date: Lab ___________________

Instructors Name _______________

• determine catheter insertion distance (when suctioning the et tube)

auscultate chest and determine breath sounds

• observe baseline vital signs

• aseptically open suction kit

• aseptically place gloves

• remove catheter from package attach catheter to suction tubing

• instill appropriate amount of sterile saline

• reconnect to ventilator (or manually ventilate) for 4 to 5 breaths

• insert catheter into Et tube without suction and advance

resuction as needed following the given criteria

• D. Document the procedure and pertinent information in the patient

Time: _______ out of possible 15 minutes.

STUDENT SIGNATURES INSTRUCTOR SIGNATURE

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